Provider Demographics
NPI:1760931869
Name:DEWITT, KASSANDRA (OTR)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:DEWITT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 BELLEVIEW AVE STE 415
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1361
Mailing Address - Country:US
Mailing Address - Phone:816-529-2802
Mailing Address - Fax:816-529-5436
Practice Address - Street 1:4700 BELLEVIEW AVE STE 415
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1361
Practice Address - Country:US
Practice Address - Phone:816-529-2802
Practice Address - Fax:816-529-5436
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016035273225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist